HomeMy WebLinkAbout947514BUREAU OF LAND MANAGEMENT
ASSIGNMENT OF RECORD TITLE INTEREST IN A
LE~ % FOR OIL AND GAS OR GEOTHERMAL RESOURCES
Mineral Leasing Act of 1920 (30 U.S.C. 181 et seq.)
Jdd9
a Act for Acquired Lands of 1947 (30 U.S.C 351-359)
CD Geothermal Steam Act of 1970 (30 U.S.C. 1001-1025)
~f .6f the Interior Appropriations Act, Fiscal Year 1981 (42 U.S.C. 6508)
Expires: October 31, 2004
Lease Serial No.
WYE-'07798B
Lease Effective Date
(Anniversary Date)
New Serial No.
CAE Type or print plainly in ink and sign in ink.
PART A: ASSIGNMENT
Assignee* SEE EXHIBIT "A"
Street
City, State, ZIP Code
U C'V2816
*If more than one assignee, check here Eland list the name(s) and address(es) of all additional assignees on the reverse of this form or on a
separate attached sheet of paper.
This record title assignment is for: (Check one) 910il and Gas Lease, or ❑ Geothermal Lease
interest conveyed: (Check one or both, as appropriate) Record Title, ❑ Overriding Royalty, payment out of production or other similar
interests or payments
7 This assignment ennvevs the following interest:
Land Description
Percent of Interest
Percent of
Additional space on reverse, if needed. Do not submit documents or agreements other than
Owned
Conveyed
Retained
Overn Similar nteor sts
this form; such documents or agreements shall only be referenced herein.
Reserved
Previously
reserved
orconveyed
a
b
c
d
e
f
Township 26 North, Range 113 West, Oh P.M., Wyoming
SEE EXH
IBIT "A."
-0-
-0-
of rec(
Section 3: Lots 5,12
containing 80 acres
RECEIVED 6/2/2009 at 11:56 AM
RECEIVING # 947514
BOOK: 724 PAGE: 286
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
FOR RLM USE ONLY - DO NOT
WRITE BELOW
THIS LINE
UNITED STATES OF AMERICA
This assignment is approved solely for administrative purposes. Approval does not warrant that either party to this assignment holds legal or
e u itable title to this lease.
Assignment approved for above described lands; ❑ Assignment approved for attached land description
Assignment approved effective MAY 0 1 2009 ❑ Assignment approved for land description indicated on reverse
By
of this form.
LA .'D LYMN EXALAY'k,"N R APR 2 9 2009
(Authorized Officer) (Title) (Date)
(CcrEthmed on reverse)
)re
t ujj ASSSIGNLi E.'
C OG287
PART B - CERTIFICATION AND REQUEST FOR APPROVAL
I. The Assignor certifies as owner if an interest in the above designated lease that he/she hereby assigns to the above assignee(s) the rights specified above.
2. Assignee certifies as follows: (a) Assignee is a citizen of the United States; an association of such citizens; a municipality; or a corporation organized under the
laws of the United States or of any State or territory thereof. For the assignment of NPR-A leases, assignee is a citizen, national, or resident alien of the United
States or association of such citizens, nationals, resident aliens or private, public or municipal corporations, (b) Assignee is not considered a minor under the
laws of the State in which the lands covered by this assignment are located; (c) Assignee's chargeable interests, direct and indirect, in each public domain and
acquired lands separately in the same State, do not exceed 246,080 acres in oil and gas leases (of which up to 200,000 acres may be in oil and gas options)- or
300,000 acres in leases in each leasing District in Alaska of which up to 200,000 acres may be in options, if this is an oil and gas lease issued in accordance
with the Mineral Leasing Act of 1920, or 51,200 acres in any one State if this is a geothermal lease; (d) All parties holding an interest in the assignment are
otherwise in compliance with the regulations (43 CFR Group 3100 or 3200) and the authorizing Acts; (e) Assignee is in compliance with reclamation
requirements for all Federal oil and gas lease holdings as required by sec. 17(g) of the Mineral Leasing Act; and (f) Assignee is not in violation of sec. 41 of the
Mineral Leasing Act.
3. Assignee's signature to this assignment constitutes acceptance of all applicable terms, conditions, stipulations and restrictions pertaining to the lease described
herein.
For geothermal assignments, an overriding royalt y may not be less than one-fourth (1/4) of one percent of the value of output, nor greater than 50 percent of the rate of
royal ty due to the United States when this assignment is added to all previously created overriding royalties (43 CFR 3241).
I certify that the statemr-'s made herein by me are true,
Executed this day of
complete, and correct to
20
the best of my knowledee and belief and are made in good faith.
Executed this
Name of Assignor as shown on current lease Kearns Tribune Corporation
~a,
Assignor
day of
Assignees
t
Alpine K' nc
_ 20
A17:1M
tl
Public reporting burden for this form is estimated to average 30 minutes per response including the time for reviewing instructions. gathering and maintaining data, and
compieting and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to U.S. Department of the Interior. Bureau of Land
Management (1004-0034.), Bureau Clearance OOiccr, (WO-630). Mail Stop 401 I-S. 1849 C Street, N.W.. Washington. D.C. 20240.
Title 18 U.S.C. Sec. 1001 makes it a crime for any person kno+singlx and willtidly to make to any Department or agency ul'thc United Slates any false, fictitious or fraudulent
statements or representations as to any matter within its jurisdiction.
EXHIBIT "A"
e: 0.62'88
Attached hereto and made part of Assignment of Record Title from:
Name
Kearns Tribune Corporation
to
Name
Alpine King Inc.
Ivers oil Company LLC
Kearns Campbell Investments
Address
1257 Third Avenue Salt Lake City UT 84103
111 E Lincoln Road Ste 4 Spokane WA 99208
217 Cedar Street #286 Sandpoint ID 83864
Percent
11.111111111
Percent
6.99999999993
2.88888888886
1.22222222221
Dated February 27 2009
Signed for Identification:
Kearns Tribune orporation +
By:
J W. Gallivan, President
STATE of Utah )
) ss
COUNTY of Salt Lake)
6289
On the 27th day of February 2009, before me personally appeared Jack W.
Gallivan who being by me duly sworn, did say that he is the President of Kearns Tribune
Corporation and that said instrument was signed in behalf of said Corporation, who duly
acknowledged to me that they executed the flame.
My Commission expires:
August 30 20 1 NOTAR~ PUBLIC
Residing at Salt Lake County
STEPHANIE BROWN
Notary Public
State of Utah
My Commission Expires August 30,1011
575 East 4600 9 Sis 9.260, Sglt lake City, UT 84111